SDC 2023 Updates

Seattle Direct Counseling and Coaching (SDC&C) has new updates for next year. Please read this post carefully, and if you are currently using my (Imei) services for counseling or coaching or you are considering one of my services in 2023 as a new client, please feel free to ask questions as to how they may apply to you.

Why are Therapists Turning Away from Third-party Payers?

The main reasons why more than a third of therapists in the U.S. do not accept any form of health insurance, or why they limit the number of health insurance programs they are credentialed with are summarized in an article on Here, I’ve taken three of the key points and added my experiences across nearly 23 years as an LMHC and over 32 years in healthcare overall.

  1. Low reimbursement rates. The insurance company sets the amount they will reimburse the therapist for the session, and then the client pays a co-payment. Unfortunately, most insurance companies have not raised the reimbursement in years, while the cost of doing business has increased. While it was helpful to accept insurance nearly 20 years ago, it isn’t as helpful now with the rising cost of goods, housing, and costs of doing business.

2. Dealing with insurance companies. In April 2022, one company decided to remove telehealth coverage suddenly, leaving unprepared clients believing their visits were covered. This is just one example in which I ended up staying on the phone with insurance companies going to bat for my clients. Because of where we are in the pandemic (it is most certainly NOT over, with more than 300 people dying of COVID-19 in the U.S. daily as of this writing), most health insurance companies wish to increase deductibles and remove telehealth coverage, passing more cost onto plan holders. That means that for many of them, they will be paying cash for as much as the first 20 visits of a year before insurance kicks in.

Therapists along with other medical practitioners have been doing their best to help clients understand the real costs of mental health services. Washington State passed a bill that requires practitioners to clarify that cost up front; the bill known as a No Surprise bill, put that responsibility on the practioner. However, when insurance companies can decide ad hoc to change their coverage, reimbursement rates, and even telehealth coverage, who is left holding the bag?

3. Supply and demand imbalance. Right now, the pandemic has contributed to high demand for therapists but not enough of us to meet that demand. In my case, I allot up to a certain amount of hours for seeing clients, and a certain amount of hours having to follow up on their insurance woes and paperwork, all for a lower reimbursement rate.

We all know that taking in a higher amount of income without increasing more hours buys us far more than trinkets and luxury items. With more stable income, we to being able to take better care of ourselves. Period.

In the current system with insurance reimbursements being lower than the going rate for therapy, a therapist would have to work longer and harder, often in the most sought-after hours (evening) to keep up with inflation and the cost of doing business.

A Solution in 2023: Hybrid Cash and Insurance

After careful consideration since April 2022, and with health insurance companies notifying us that telehealth coverage costs that had been waived in the pandemic will end on Dec. 31, 2022, SDC&C will pivot to a hybrid model. Of the 20 hours allotted per week for counseling clients, I will be holding:

*12 client hours per week for current clients who are using their employer based health insurance, until my contracts with the health insurance plans end (2024 and 2025)

*8 client hours per week for new clients who will be paying cash only for their sessions.

Of the remaining hours, I will be taking cash-only coaching clients (currently not covered by insurance) to help keep my practice healthy and balanced.

Eventually, the natural end of the contracts with these health insurance plans will give time to those who are already using their plans to pay for therapy to look ahead to what their needs might be and carefully anticipate what actions to take when the contracts end and I do not renew them.

How Will I Pay for Services Without Using My Health Insurance?

If you are coming on board into the counseling community as a new client of counseling or for my coaching programs (not currently covered by insurance), or you have lost your job recently and have pivoted to paying out of pocket, here is what I would ask you to consider:

  1. The cost of therapy is considered a medical expense that you can track for your tax return; therefore, you may qualify for a deduction at tax time to help offset the cost.
  2. If you are in economic hardship, you can discuss a plan with of me with what you are able to reasonably sustain for a time-limited period.
  3. If you choose to seek help through Public Health or other community settings supported by state funding, please feel free to ask about how to go about this.
  4. Good mental health care relies in part with timely and effective access. If you are in need NOW, putting off care until you perceive you can afford it may have more negative consequences. Even if I cannot directly meet your needs, I am a resource who has helped many find where to go to get their needs met in a timely way.
  5. You are always welcome to receive a referral from me for another practitioner who accepts your insurance. It would be fair to note that waiting times to get an appointment could be substantial, so I suggest you plan accordingly.

So… What Now?

In summary, the hybrid payment model goes into effect Dec. 31 2022. My office officially closes for the holiday season on Dec. 22 2022, with the office reopening on Jan. 9.

Traditionally, this time of year is very quiet as most of us prepare for various family gatherings, celebrations, and special traditions. I am doing the same, and always with a compassionate heart towards those who are seeking ways to improve their mental wellness and deep health concerns. While I may not be responsive during the break when the office is closed, please feel free to send forward any questions you may have either during your meetings with me or by email, and you will hear from me, just within a longer than normal time frame (approximately 3-5 days versus 24-hours).

Client-centered Therapy coaching Counseling Psychology Technology Telehealth

What To Look for In A Telehealth Therapist

When looking for a distance provider, also known as a telehealth provider, do you know what to look for? Here’s my quick-tip guide. Photo: screen capture of the nation’s most popular therapist search engine.

Starting June 2017,  Seattle Direct Counseling services will transition from 20% telehealth services (online and phone) to 100% telehealth (not counting presentations, interviews and podcasts, and email communications). This transition begs the question, “What should I look for in a telehealth therapist?”

Here is my short list of things you should look for when seeking a therapist who uses telehealth options as their primary way of delivering mental health and coaching services using accepted technological platforms and devices.

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Someone In Your Corner

Someone In Your Corner: Why Counseling and Coaching Makes Dollars and Sense
by B. Imei Hsu, BSN-RN, MAC-LMHC, Artist

I hadn’t taken her out for a ride in 18 months. Sleek, black, with a three-gallon tank and 120 miles of giddy-yup per fill-up, my BMW F650 motorcycle had accompanied me the past 12 years through years of marriage, divorce, and singleness, on long commutes to the office, on short rides to chase the Fall leaves, and mini trips to the San Juan Islands. But I was made an offer that I could not refuse. Last week, I sold the bike I had no time to ride this season for the thing that I was making time for: writing a book. And with the value of the bike, I gained a book publishing coach, author, and presenter Patrick Snow to help me get my book finished, edited, and published as a paper book and in all eBook format. The bike also secured his coach-for-life program, to help me grow my own plans to meet the market demand for authors, presenters, and best-practice coaches in my field. Why would I sell my bike for this? Why should you consider hiring a coach? Because it is important to have someone in your corner.